The Council for Medical Schemes (CMS) has suspended general manager of compliance and investigations Stephen Mmatli. The Council for Medical Schemes (CMS) has suspended general manager of compliance and investigations Stephen Mmatli “following tip-offs related to his conduct in the affairs of the regulator”, the council announced on Sunday. He is accused of deliberately deceiving..
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General Manager of the Medical Scheme Council is suspended after it came to light that he misled counsel around decisions taken in favor of certain organizations
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Need to know information:- What to look out for when choosing a medical scheme
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Are your health insurance costs too high? Try decoding your medical aid terms and conditions and associated costs to make sure that it works for you.
“While health insurance is important, it comes at a cost that is rapidly rising. Unfortunately for the consumer, this affects medical scheme membership contribution rates, and the increases of which are sometimes significantly higher than general inflation.
As schemes try to contain their costs in the face of increasing claims, they make changes to their plans and benefits, which can come as a surprise to the consumer,” says Mark Payne, CEO of the Independent Community Pharmacy Association (ICPA).
Annual review of your plan
He recommends that an annual review of your plan is absolutely vital, and will affirm that it is serving your needs rather than the other way around.
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The biggest medical aid schemes in South Africa – and how much they’re charging in 2018
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The majority of South Africa’s biggest medical aid schemes have released their prices for 2018, showing below 10% increases across all plans.
According to the latest statistics released by the Council for Medical Schemes (CMS), there are currently 82 medical aid schemes operating in South Africa with a total subscription of just under 8.9 million members as at December 2016.
Discovery remains the largest medical aid scheme in the country, with over 2.7 million members.
This is followed by the Government Employees Medical Scheme (GEMS) with 1.8 million members, and the Bonitas Medical Fund, with just under 680,000 members.
Due to the nature of medical aids, and how each scheme is structured to cater for different hospital networks and cover different medical needs, it’s incredibly difficult to compare like for like, especially on price.
However, with all medical aids now releasing their contribution structures for 2018, the tables below outline the pr
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Experts decry plan to consolidate small medical schemes !!
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The plan by the Council for Medical Schemes (CMS) to consolidate or dissolve small medical schemes posed risks to the people who belong to these schemes and might force some to drop their cover, industry sources warned this week.
More than 228,000 people belonged to 31 medical schemes that had fewer than 6,000 members at the end of 2015, according to the CMS 2015-16 annual report. All but three of these schemes are restricted employer groups. Restricted employer group schemes generally subsidise members on low incomes, enabling them to buy cover they could not afford on the open market.
CMS acting registrar Sipho Kabane said consolidating the industry was in line with the white paper on National Health Insurance (NHI).
Medical schemes with fewer than 6,000 principal members were targeted as they fail to meet the requirements of the Medical Schemes Act. The act says schemes must have 6,000 members to register.
Consolidation was necessary because fragmented r
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Do you really think you’re going to opt out of the NHI when it comes?
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1. Will you be able to say “thanks, but no thanks”?
If the National Health Insurance (NHI) Bill is passed in its current form, the NHI will be compulsory, regardless of whether you also belong to a private medical aid. So, opting out won’t be possible. The Bill says the NHI, which will be like a big, state-funded medical scheme, will be a free service, but it doesn’t tell us what benefits will be covered, how the scheme will be paid for or how much it will cost.
2. When will the NHI start, and, will it actually happen?
The NHI Bill says the scheme will be implemented in three phases — we’re currently in the second phase (2017 – 2022), during which NHI legislation has to be developed and the NHI fund has to be established. During the last phase, from 2022 – 2026, Cabinet has to approve “the mobilisation of additional resources” so that the NHI can start to buy healthcare services from both public and private providers
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Syndicates and devious health professionals may target National Health Insurance
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Criminal networks are targeting your medical aid rands but could you be part of the problem too?
Criminal syndicates and unscrupulous doctors may be defrauding the private health sector of millions as experts warn that medical schemes may reach a breaking point.
“The health care sector is being targeted by criminal syndicates and even devious practitioners. It is a direct threat to the financial viability of medical schemes in the country, including any National Health Insurance initiative we attempt,” says medical advisor on healthcare forensics at medical aid administrator and risk management service, Medscheme Gregory Pratt. Pratt was speaking at the Board of Healthcare Funders Southern African Conference this week in Cape Town.
“The affordability of medical schemes in the country will soon reach a tipping point.”
In 2013 alone, Discovery Health recovered R300 million in fraudulent claims alone – a number that in 2014 CEO Jonathan Broomberg told
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Anger over medicines supply scheme
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It is crucial for the Rev Isaac Harley to take his medication daily – it’s a matter of life and death really.
As a diabetic with a hypertensive comorbidity, he depends on his tablets and insulin to maintain his insulin levels and to manage his high blood pressure.
But it’s been one problem after the next, he told The Sunday Independent, since his medical aid recommended he use its pharmacy’s direct service to deliver his chronic medication to his address instead of claiming from a local pharmacy in his neighbourhood, Elsies River in Cape Town.
“On more than one occasion I’ve had to call to find out what had happened to my medicine.
“During one stint I had no medicines for two weeks because of delivery delays and I didn’t have funds so I had to borrow medication from my mother, who is also diabetic, and money from friends to get the other medication privately,” the 48-year-old said.
In a battle spanning several years, the Independent Community
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Hospital cash-back plans crimped by new law
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The demarcation regulations clearly distinguish between medical insurance products and medical aid schemes. For the consumer, this means that while limited gap cover and hospital cash-back plans will still be allowed, primary healthcare insurance policies will no longer be available. All existing policies will need to align with the regulations from 1 January 2018.
Affected markets
These regulations will primarily affect those between 20 and 35 years of age. The annual Council for Medical Schemes (CMS) report shows that children up to the age of 20 usually stay on their parents’ medical aid. Then you see a significant drop in the number of dependents between the ages of 20 to 35, and then the line goes up again. This is a clear indication that the young and healthy are exercising their freedom of choice to not have medical aid cover. This is the group that, until now, has often relied on hospital cash-back plans for catastrophe cover.
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You might ask the following question regarding the NHI:- Will I be able to opt out of the NHI?
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In June, the health minister released the long-awaited National Health Insurance Bill. What does it mean to you and your medical aid? We tell you.
1. Will you be able to say “thanks, but no thanks”?
If the National Health Insurance (NHI) Bill is passed in its current form, the NHI will be compulsory, regardless of whether you also belong to a private medical aid. So, opting out won’t be possible. The Bill says the NHI, which will be like a big, state-funded medical scheme, will be a free service, but it doesn’t tell us what benefits will be covered, how the scheme will be paid for or how much it will cost.
2. When will the NHI start, and, will it actually happen?
The NHI Bill says the scheme will be implemented in three phases — we’re currently in the second phase (2017 – 2022), during which NHI legislation has to be developed and the NHI fund has to be established. During the last phase, from 2022 – 2026, Cabinet
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What the National Health Insurance means for you & your pocket
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Two Bills, almost 200 pages may change healthcare forever in SA. Haven’t read them? We did the heavy lifting so you don’t have to.
Love it or hate it: The country continues to move forward with introducing its universal healthcare scheme the National Health Insurance (NHI). – see photo below video
Last week, Health Minister Aaron Motsoaledi introduced the draft Medical Schemes Amendment Bill and NHI Bill in Pretoria. The new legislation proposes significant changes to the way healthcare is funded and managed that could have far-reaching effects on you, your family and your pocket book.
Take a look at some of the proposals that have the minister already gearing up to go to court. Then watch to hear how the minister plans to make the most of your unspent premiums as the Council for Medical Schemes plans to lower the mandatory amount schemes hold in reserve to free up more cash for health.
[embed]https://www.youtube.com/watch?v=-2gwAu3scp0&feature=youtu.be
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New Act could redress medical scheme sustainability issues
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Health Minister Aaron Motsoaledi has hinted at a number of reforms that directly address challenges of sustainability that the medical schemes industry is currently facing.
“We know that rising costs in healthcare are outstripping inflation, and legislated steps to address this are overdue. The proposals will usher in a new set of rules for how medical schemes operate,” says Mark Arnold, principal officer of Resolution Health Medical Scheme.
“While the details of how uniform tariffs for healthcare providers will be arrived at are not expected to be addressed in the Medical Schemes Amendment Bill, but rather will be informed by the outcome of the Competition Commission’s Health Market Inquiry, this is an important step towards protecting healthcare consumers.”
Looking for a affordable Medical Aid or Hospital Plan, just click here Medical Aid or just
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The POPI Act:- What it means for medical aid schemes
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When implemented, the Protection of Personal Information (POPI) Act will fundamentally change the way personal data is managed. Corporate South Africa, including medical aid schemes, insurance brokers, financial advisors, marketers and even brands need to start preparing now for its impact.
“A patient’s medical information and history are particularly sensitive,” says Gerhard van Emmenis, principal officer of Bonitas Medical Fund. “Which means the entire service chain, from medical practitioners to pharmacists, administrators and scheme, involved in receiving and storing this information will be required to meet the stringent POPI requirements.”
Looking for a affordable Medical Aid or Hospital Plan, just click here Medical Aid or just send your Name, surname, age and email address to 082 738 5586
Essentially POPI, based on European legisl
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10 reasons why medical malpractice is threatening SA healthcare
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According to an Econex survey commissioned by the Hospital Association of South Africa (Hasa) in 2015, there were just 60 doctors per 100,000 people in 2013; whereas the world average is 152. The emigration of healthcare professionals adds to South Africa’s doctor shortage – a situation which is placing the country’s entire healthcare system at..
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